Insurance Agent Forum

[glenwmr]

Hello all, I've never posted, but have read and learned LOTS... so thanks to everyone who posts in this forum.

I'm in Dallas, TX and new as an independent agent. I've worked in health insurance for over 8 years, just not as a broker. So, here's a question I have:

For MA plans, what is the difference between the annual enrollment period (Nov 15th - Dec 31st), and the open enrollment period (jan 1 - mar 31st)? Who are the different types of people to market to during these periods?

Why do people call this time the "selling season"?

As a new agent, am I basically unaffected by this period this year because I have no current clients that would want to change plans at this point?

Thanks for any help!

Mark

[GreenSky]

Originally Posted by glenwmr

Hello all, I've never posted, but have read and learned LOTS... so thanks to everyone who posts in this forum.

I'm in Dallas, TX and new as an independent agent. I've worked in health insurance for over 8 years, just not as a broker. So, here's a question I have:

For MA plans, what is the difference between the annual enrollment period (Nov 15th - Dec 31st), and the open enrollment period (jan 1 - mar 31st)? Who are the different types of people to market to during these periods?

Why do people call this time the "selling season"?

As a new agent, am I basically unaffected by this period this year because I have no current clients that would want to change plans at this point?

Thanks for any help!

Mark

AEP allows people to do anything they want. The OEP allows people to make like for like changes.

As an example, if someone did not buy a PDP a year ago, they can get one (with penalty) during AEP. But once Dec. 31 passes, they cannot get a plan during the OEP.

If someone already has an MAPD and it's Jan 15, then they can change into another MAPD, an MA and a PDP, etc. No new coverage, just a change in coverage.

The selling season is just that. Nov 15 - Dec. 31 and then Jan 1 - Mar. 31. Each and every one of us makes so much money in the 4 1/2 months that we don't need to work the rest of the year.

Rick

[senior-advisor-indiana]

I only worked 4 and 1/2 months a year before PFFS plans.

[Kimber]

I agree with Rick, but also please note that after January 1 the client can only make one change. Up to December 31, the last app processed by CMS is the one which sticks, however after Jan 1, it is the first one which "wins" the business for the benefit year.

[retread]

Glad you pointed that out, Kimber. I think this went over the head of many out there, at least from the conversations I overheard this year. It is amazing how little attention some agents give to the wording in regulations. I know we are not all lawyers, but it is incumbent on us to do our due diligence and READ THE RULES CAREFULLY!

[glenwmr]

Great Info! Thanks for replying. So, let's see if I got it?

AEP - 11/15 - 12/31

Example: Somone is on a med supp and wants to enroll in an MA plan. They enroll in the MA plan, and discontinue their Med Supp premiums (if they want -- I know they don't have to technically terminate their Med Supp).

Example: Someone just on original Medicare wants to select an MAPD plan. They can during this time.

OEP - 1/1 - 3/31

Example: Someone with SecureHorizons wants to change to Humana because they don't like the service they receive when they call customer service.

Example: Someone with the ANY ANY ANY plan wants to come off the PFFS plan because their hospital does not accept the plan, and they want to get an MAPD PPO plan through Aetna.

Do I have it???

[retread]

Yes... as long as the PFFS plan had a drug benefit (MAPD), because a PPO will always have a drug plan (MAPD). Some PFFS plans are MA only, so be careful there.

[glenwmr]

Originally Posted by retread

Yes... as long as the PFFS plan had a drug benefit (MAPD), because a PPO will always have a drug plan (MAPD). Some PFFS plans are MA only, so be careful there.

I see. So, it truly has to be a like-like change during open enrollment. They can't go from a plan without prescription drugs to a plan with prescription drugs. Suppose, they were on a PFFS without any prescription drug coverage, and they wanted to get on a MAPD, would that have to take place during the AEP?

I know this is a technical, boring question, so I appreciate you taking the time to show me the ropes!

I also see the other thread "Like to Like - OEP" going on as well... that is somewhat helpful. (I think.)

Mark

[al3]

Originally Posted by glenwmr

They enroll in the MA plan, and discontinue their Med Supp premiums (if they want -- I know they don't have to technically terminate their Med Supp).

I was told that by law you can't have both an MA and a Supp.

Did I receive bad information? Or are the benefits co-ordinated?

Al

[honestagent]

Originally Posted by al3

I was told that by law you can't have both an MA and a Supp.

Did I receive bad information? Or are the benefits co-ordinated?

Al

Al, you are correct. As of 07, (haven't read 08 publication on this yet) they can keep their med. supp why they try out a med. advantage but they will get very little or no use out of it. Mostly no use. The purpose is for them to maintain their premiums and if they don't like new program, they can disenroll (during non lock in times) and they'll still have their med sup with no gap of coverage... so if something happens during the interum of the drop - they have insurance!!!!

But yeah, you CANNOT have both; it's one or the other. and in terms of coordination - off topic - like group retirement bennies... wow be careful because even if you call and they say the do coordinate, most of them still do not. had a few clients where we called, the blues said they do, they even wrote a letter stating they do, and they ended up not coordinating. Good rule of thumb, if they have a good group plan, leave em there... unless they want out. This is b/c if they leave the group, they are not guarantteed to come back should they want to down the road. Thought I'd throw this in too since we're talking about coordination of benefits.

Does this help you? As for 08, cannot say yet. Haven't had a chance yet to read up on it but will soon.

[Cenla Agent]

Originally Posted by al3

I was told that by law you can't have both an MA and a Supp.

Did I receive bad information? Or are the benefits co-ordinated?

Al

You can't have two Supps by law, IIRC. Technically you can have a Supp and MA but a Supp is worthless if you have MA. What the OP was getting at is that no one should drop a supp until their MA enrollment is confirmed. I think I only replaced one supp last enrollment season, mainly due to the high price of the plans I was selling. Almost all of my enrollments were people who only had Original Medicare who couldn't afford or qualify for a Supp.

[jkbrown]

Hi,
I'm a knew agent and have a question regarding open enrollment also. I was told that if you don't have all your credentials in place by November 15, that you will not be able to enroll anyone for MA. Is that true!

[retread]

This is one of those hazy areas. Here I am going to express my opinion, so be careful...

I know of no regulation that will prevent you from selling MA plans after Nov 15th, AS LONG AS YOU GET APPOINTED AND CERTIFIED FIRST. In other words, you can't approach anyone to sell until you are qualified beforehand, and that could be as late as the last week of December. HOWEVER, the FMO (if you are independent) or the carrier (if you are captive) will most likely have a cutoff date for certification.

I doubt seriously you will get appointed and certified after November 15th, but that is just my opinion.

[GreenSky]

Originally Posted by jkbrown

Hi,
I'm a knew agent

What's a knew agent? Someone who sells knows?

Rick

[senior-advisor-indiana]

Originally Posted by GreenSky

What's a knew agent? Someone who sells knows?

Rick

Oh c'mon Rick! You new what he was talking about.

[OneMorePolicy]

Originally Posted by retread

This is one of those hazy areas. Here I am going to express my opinion, so be careful...
the FMO (if you are independent) or the carrier (if you are captive) will most likely have a cutoff date for certification.....
I doubt seriously you will get appointed and certified after November 15th, but that is just my opinion.

I can't speak from personal experience yet, but I'm in the midst of trying to get appointed\certified now (Jan 2008), especially since it looks like UHC\Evercare for duals can be sold year-round. I have seen cutoffs (was it Humana?) but Evercare still looks open.

[MAPDJim]

I sent my UHC app to my FMO on 11/14/07. I find out on 12/27/07 they (Secure Horizons got my app on 11/21/07) were waiting for my E/O. Amazing thing is I waited for my E/O to get written before sending my app with the E/O number on the front page. I refax my E/O on 12/27/07.

The next week )last week) I call Secure Horizons and they then tell me they had my E/O on 12/4/07 and it must have been someone else's E/O they were missing. Now they say they are just reviewing background check and I should be all set after that.

I called for 3 straight days last week and was told my file was pulled and on someone's desk and that they would call me back each day. No call.

Then on Friday I am told..."Sorry to say but we lost your app and could you refax it. (My dad was a postal worker, it's in my genes...grin)

My FMO has done nothing to help and never calls me back. Luckily I got signed on here in CT with Connecticare straight up with no FMO needed and it took less than a week. They by far have the best MA and MAPD for CT but I would like to have the Evercare SNP for the chronically ill folks.

I won't even begin to tell you about Healthnet...yes I will. I live in the only county in CT where the major hospital is not in network for Connecticare. So I need Healthnet for their zero premium MAPD. (we have about 150 senior clients in this county that are available to us that we can't market a zero premium plan to)

The manager at Healthnet has not returned 3 calls (trying to get appointed) and responded to my email with a "the next training is in February, I'll let you know when it is." Must be nice to have such a great job you don't need my 100 apps I could give them.

This was/is my first venture into the MAPD arena. Being in the reverse mortgage business I figured this would be some good money as well as find future reverse mortgage clients.

Combine all that with the appointment setting company crap that went down today and I'm wondering...why?

But...being that I've been through tougher things I'm sure eventually I'll come out the other side just fine.

[salpro22]

Originally Posted by MAPDJim

I sent my UHC app to my FMO on 11/14/07. I find out on 12/27/07 they (Secure Horizons got my app on 11/21/07) were waiting for my E/O. Amazing thing is I waited for my E/O to get written before sending my app with the E/O number on the front page. I refax my E/O on 12/27/07.

The next week )last week) I call Secure Horizons and they then tell me they had my E/O on 12/4/07 and it must have been someone else's E/O they were missing. Now they say they are just reviewing background check and I should be all set after that.

I called for 3 straight days last week and was told my file was pulled and on someone's desk and that they would call me back each day. No call.

Then on Friday I am told..."Sorry to say but we lost your app and could you refax it. (My dad was a postal worker, it's in my genes...grin)

My FMO has done nothing to help and never calls me back. Luckily I got signed on here in CT with Connecticare straight up with no FMO needed and it took less than a week. They by far have the best MA and MAPD for CT but I would like to have the Evercare SNP for the chronically ill folks.

I won't even begin to tell you about Healthnet...yes I will. I live in the only county in CT where the major hospital is not in network for Connecticare. So I need Healthnet for their zero premium MAPD. (we have about 150 senior clients in this county that are available to us that we can't market a zero premium plan to)

The manager at Healthnet has not returned 3 calls (trying to get appointed) and responded to my email with a "the next training is in February, I'll let you know when it is." Must be nice to have such a great job you don't need my 100 apps I could give them.

This was/is my first venture into the MAPD arena. Being in the reverse mortgage business I figured this would be some good money as well as find future reverse mortgage clients.

Combine all that with the appointment setting company crap that went down today and I'm wondering...why?

But...being that I've been through tougher things I'm sure eventually I'll come out the other side just fine.

I'm in Stamford....where are you located at?

[MAPDJim]

Montville, down near Mohegan Sun.

[salpro22]

Originally Posted by MAPDJim

Montville, down near Mohegan Sun.

Ok. I have to visit that place one of these days. What FMO are you using. Feel free to PM me if you rather things be kept confidential.